Rehab providers offer study results to argue against site-neutral payments

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Patients generally have better clinical outcomes and live longer if they are treated in an inpatient rehabilitation hospital rather than a skilled nursing facility, according to a study commissioned by the American Medical Rehabilitation Providers Association. The findings show why IRFs should be reimbursed at a higher Medicare rate than SNFs, the trade association argued when releasing the results Tuesday.

The study looked at more than 100,000 pairs of Medicare beneficiaries for two years, comparing what investigators described as "clinically similar" patients in IRFs and SNFs. The patients in the inpatient rehab facility had a mortality rate 8% lower than those treated in skilled nursing facilities, according to the researchers from Dobson DeVanzo & Associates LLC.

For five of 13 conditions studied, the IRF patients had significantly fewer hospital readmissions per year than their counterparts in SNFs, the researchers found. The readmission rate for amputations was 43% lower for patients in inpatient rehabilitation facilities. Overall, the IRF patients experienced 4.5% fewer trips to the emergency room per year.

Congress reportedly is considering matching IRF and SNF Medicare reimbursements, which generally would result in lower payments to the inpatient rehab providers. The savings to Medicare could help offset the costs of a permanent repeal of the Sustainable Growth Rate formula for setting physician reimbursement levels. These study results show that IRFs provide a higher level of care than skilled nursing facilities and should be reimbursed accordingly, AMRPA argues.

The Medicare Payment Advisory Commission has not yet issued a recommendation on site-neutral payments, but most of its members support the policy, Chairman Glenn Hackbarth has said. The commission has seen research showing similar clinical outcomes across the two settings.

The nation's largest long-term care provider association, the American Health Care Association/National Center for Assisted Living, supports site-neutral payments. 

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